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Indeed, there are no scientifically rigorous studies that examine psychotherapy with Orthodox Jews (Margolese, 1998,
p. 38). Ironically, Bilu and Witztum (1993) suggested that
transcultural therapy involving this group is more complex
than with any other diverse group. Moreover, there is evidence that Orthodox Jews, and particularly the newly religious, suffer increased rates of severe psychiatric disorders
(Bilu & Witztum, 1993) and are increasing as a proportion of
Jews entering psychotherapy (Wikler, 1986). Their numbers
in therapy are almost certain to continue rising, because their
community is presently awakening to the reality of their
mental health needs (Lightman & Shor, 2002; Shaviv, 2002;
B. Twerski, 2002) and experiencing a dramatic (Sorotzkin,
1998, p. 94) increase in readiness to accept help from the
mental health profession in meeting those needs.
As with any minority group, there are circumstances when
it may be beneficial or time-saving for the Orthodox Jew
simply to engage a counselor or therapist who shares similar
religious beliefs and cultural values (Simmons, 2001), yet
there are few available (Bilu & Witztum, 1993). Furthermore, even when they are available, they may represent a
poor choice for the patient. For example, even a slight variation in religious commitments may trigger suspicion on the
part of one or the other. In addition, countertransference
arising from the Orthodox professionals own unresolved
religious conflicts may complicate matters (Rabinowitz,
2000). Moreover, university-educated Orthodox Jews are
sometimes outright hostile to their more traditional
coreligionistsor may be suspected by the client of being
such a traitor (Bilu & Witztum, 1993; Greenberg, 1991).
Given the frequent complexity of using an Orthodox Jewish counselor or therapist, and their relative scarcity, the
option of a non-Orthodox or non-Jewish one must be considered. Indeed, many mental health professionals suggest
Eliezer Schnall, Psychology Department, Yeshiva University. This article is dedicated to the authors parents, David and Tova
Schnall, for their love and support. He is also grateful to Sharon Brennan and William Di Scipio for their encouragement on this
project. Finally, the author acknowledges the late Stephen Weinrach, whose work was an inspiration for this article. Correspondence concerning this article should be addressed to Eliezer Schnall (e-mail: eschnall@aol.com).
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differences may, at times, be imperceptible to outsiders, members of the subgroups take them very seriously (Wikler, 2001).
The most traditional Orthodox Jews are sometimes called
Ultra-Orthodox, as opposed to modern Orthodox. Although such labeling may seem convenient to researchers, many within that community find it offensive and
insulting (Lightman & Shor, 2002; Weill, 1995.) Furthermore,
in categorizing, one implies that the Ultra and modern Orthodox are distinct and form homogenous groups. Actually, Orthodox Jewry forms a spectrum and cannot easily be divided
into neatly defined segments. Even if such terminology were
accurate, it might actually serve to confuse clinicians because
within a single family it is not uncommon to find modern
Orthodox parents whose children hold Ultra-Orthodox views,
often because these parents selected Ultra-Orthodox institutions for their childrens education.
To avoid misleading and offensive labels, I simply refer
to Orthodox Jews, although original sources may have attempted to be more specific. As a guideline, however, when
counseling Orthodox Jews who are more culturally and religiously identified, the issues raised in this article are likely
more relevant than when counseling those who are more
modern. In any event, as with all cultural diversity literature, the reader is cautioned against making assumptions
about every individual Orthodox Jewish client. The intent
is to highlight the issues a therapist or counselor may encounter with this population.
Institutional Barriers
Certain characteristics of the Western mental health care
system as it is presently organized are incompatible with the
needs of the Orthodox Jewish community. As a result, it
becomes less likely that members of this group will seek or
receive adequate care. These institutional barriers are the
focus of the present section.
To the Orthodox Jew, seeking psychological help may
seem to reveal personal weakness. He or she may view it as
admitting that Orthodox Judaism does not have all the answers (Strean, 1994, p. 39). Furthermore, members of this
group may be under the impression that Jews are high
achievers, and shouldnt (Zedek, 1998, p. 260) require
the assistance of mental health practitioners.
The fact that therapists and counselors are university educated indirectly contributes to another problem. Many Orthodox Jews view mental health workers as representatives of the
unchaste and decadent secular world from which they try to
isolate themselves and their families (Bilu & Witztum, 1993).
They assume that these professionals will challenge their values and possibly even attempt to deconvert (Heilman &
Witztum, 1997, p. 523) them from religious belief.
Orthodox Jews may also fear that counselors and therapists
will not respect values that are important to their community
(Sublette & Trappler, 2000). For example, there may be con-
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cern that the secular professional will disregard the domestic tranquility of the family unit (shalom bayis) or will be
quick to report problems to the governmental authorities
that their community prefers to deal with internally
(Lightman & Shor, 2002). Tens of centuries of persecution
and pogroms, culminating with the Nazi Holocaust, have
led many Jews to be suspicious of outsiders, wondering
whether they may be anti-Semitic or have ulterior motives
(Sublette & Trappler, 2000; Zedek, 1998), and those with
the strongest commitments to Judaism may be the most likely
to exhibit this suspicion. Finally, Orthodox Jews may fear
that therapy will require interaction with members of the
opposite sex in ways discouraged or prohibited in their culture and tradition.
The many rabbinic responsa (as cited in Greenberg &
Witztum, 1994a) that discourage dealing with secular mental health professionals only serve to underscore this mistrust on the part of Orthodox Jewish clients. Moreover, classical Jewish texts are often critical of the medical profession
generally (Margolese, 1998). Greenberg (1991) observed that
the modern Hebrew term for psychiatry is briyut nefesh and
that the latter word literally translates as soul, a word with
religious and Kabbalistic mystical overtones, which may
confuse Hebrew-speaking Orthodox Jews. They will likely
wonder how a non-Jewish or irreligious counselor or therapist, using secular knowledge, can understand a metaphysical entity like the Jewish soul.
It should also be noted that many Orthodox Jews turn
first to a rabbi if they have social or emotional difficulties.
Results of a survey conducted by Wikler (1986) found very
few instances where Orthodox Jews in therapy had been sent
by their rabbis. Presumably, rabbis were discouraged from
referring to psychotherapists because of the same factors
that discourage Orthodox Jews generally from seeking help
from psychotherapists.
Many Orthodox Jews also claim that their community
attaches a stigma to those receiving psychological help
(Feinberg & Feinberg, 1985). They fear that anyone who
learns of their situation will consider them crazy or insane (Wikler, 1986, p. 117). This stigma is compounded by
the importance Orthodox Jews place on family background
when considering a partner for marriage, which is often
wholly or partially arranged after careful investigation
(Rockman, 1994a). As such, Orthodox Jews often fear that
by seeking therapy they are ruining their siblings or
childrens chances of finding a suitable match or, needless
to say, their own (shidduch anxiety; Greenberg, 1991;
Margolese, 1998; Sublette & Trappler, 2000; Wikler, 1986).
Furthermore, the close-knit nature of their communities
makes it difficult to keep such things a secret.
Although some of the previously discussed issues may
be unique, many Orthodox Jews must overcome another barrier to mental health care commonly encountered by other
minority groups. Often because they have chosen religious
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fulfillment of the religious obligation to heed rabbinic directives. The clinician may thus be surprised that the apparently motivated client displays little desire to engage in the
work of the counseling or therapy itself (Rabinowitz, 2000).
In addition, Orthodox Jewish clients who have never engaged in any form of psychotherapy may bring with them
some very unhelpful preconceptions. They likely have had
experience discussing a variety of issues with their rabbis,
who often supply a teshuva, or response, to a posed
sheela, or question. This type of interchange differs
markedly from the self-exploration often encouraged in
therapy, which may disappoint a client who has different
expectations (Greenberg, 1991).
Western-trained mental health professionals may have
particular difficulty counseling Orthodox Jewish women,
whose role in the family is easily misunderstood. Although
they may have jobs, these women are often uninterested
in, or discouraged from, careers, and their primary roles
are seen as wife, mother, and homemaker (Goshen-Gottstein,
1984). However, contrary to what that situation may mean to
the counselor or therapist, at least ideally, the Orthodox Jewish woman is seen as complementary, not subordinate, to her
husband (Margolese, 1998). As the Talmud (Tractate
Sanhedrin) states, A husband must love his wife as himself
and honor her more than himself (folio 28).
Outsiders may also misunderstand other aspects of Orthodox Jewish spousal relations. To some within this community, the terms love, romance, and sex life may have little
relevance, because they view marriage primarily as a means
to raise a family. That does not mean that husbands and
wives do not share intimacy and affection, but it does mean
that their definition of marriage may differ substantially
from the definition common in Western society (GoshenGottstein, 1987). Like almost every area of Orthodox Jewish
life, sexual relations are guided by strict laws, which, if unfamiliar to the therapist, will substantially complicate marital
therapy. (See especially Lamm, 1966. Ostrov, 1978, may also
be helpful. Rockman, 1994b, provided a thorough summary
of the topic, although inaccurate on at least one point.)
The issue of countertransference is also important when
working with this population. Like all minorities, Orthodox
Jews are often seen as being inferior by the majority culture.
Even Orthodox Jews, and certainly the non-Orthodox, may
feel antagonism toward the most traditional Orthodox Jews
who have chosen to study full-time in place of a normal
occupation. This is particularly poignant in Israel, where
many secular Jews feel that those Israelis who do not serve
in the army or work for a living are leeches on the rest of
society (Greenberg, 1991).
Some Jewish mental health workers may also suffer embarrassment at the perception that they are identified with
the backward Orthodox clients by their non-Jewish colleagues. In addition, counselors and therapists of all types
may make the mistake of trying to replace religion with
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